The use of school milk as a vehicle for fluoride in Knowsley, UK; an evaluation of effectiveness.

OBJECTIVE: To compare caries in children initially aged 3 to 5 years who had participated for four years in a fluoridated school milk programme with a group of children in a similar community drinking non-fluoridated milk. STUDY DESIGN: A four-year longitudinal study measuring caries experience and caries increment in primary molars and caries experience in permanent molars and incisors. METHOD: 478 children in Knowsley (test group) and 396 in Skelmersdale (comparison group) were examined for caries (dmft/dfs) at baseline in 1997. Of these, 318 in Knowsley and 233 in Skelmersdale were re-examined at follow-up (dmft/dfs and DMFT/DFS) in 2001. RESULTS: The mean ages at baseline of the children from the test and comparison groups were 4.7 and 4.8 years respectively. The baseline dmft/dfs was 1.73/2.51 in the test group and 1.29/2.15 in the comparison group. The 4-year dmft/dfs mean increments were 2.28/4.49 and 1.96/4.12 in test and comparison groups respectively. The DMFT/DFS at age 7-9 years in the test and comparison groups were 0.40/0.45 and 0.40/0.55 respectively. CONCLUSION: The fluoridated school milk scheme, as configured in Knowsley. Merseyside, did not reduce caries within the primary dentition and, at best, had a small clinical impact on the permanent dentition up to 8 years of age.

School milk as a vehicle for fluoride in the United Kingdom. An interim report.

OBJECTIVE: To consider the feasibility of using school milk as a vehicle to deliver fluoride to children, suffering from high rates of dental disease, in socially deprived districts. METHOD: The legal aspects of adding fluoride to milk and availability of milk subsidies were updated. The organisational requirements of using school milk as a vehicle for fluoride were investigated and the consultation process established. The uptake of fluoridated milk was monitored and the fluoridated milk was subjected to rigorous quality control. The costs involved in running a scheme were calculated. OUTCOME: Fluoridated milk can now be called milk with added fluoride and to date the product has attracted subsidies from the European Economic Community and from the Welfare Foods Section in the Department of Health. The demonstration scheme in St. Helens, Merseyside, generated interest from neighbouring health authorities leading to the subsequent expansion of the programme. By working with the dairy, recommendations to improve the quality of school milk have been developed. The main organisations involved in running school based milk fluoridation schemes have been encouraged by the low costs involved. CONCLUSION: The UK programme has demonstrated that it is feasible to use school milk as a vehicle to deliver fluoride on a community basis. Attention must be given to improving the quality and particularly the temperature control of school milk.

Determination of fluoride intake from urinary fluoride excretion data in children drinking fluoridated school milk.

Twenty-four-hour urine samples were collected from each of thirteen 5- to 6-year-old children both under customary conditions of fluoride intake (i.e. usual diet including milk containing 0.5 mg fluoride and usual oral hygiene procedures with fluoride toothpaste) and during a 4-day study period in which their customary fluoride intake was replaced with standard fluoride doses. The 24-hour fluoride excretion under customary conditions of fluoride intake was 0.30 mg and in response to fluoride doses in the range of 0.5-2.0 mg it was in the range 0.26-0.61 mg. Using data obtained during the study period for all subjects combined, the fluoride intake from all sources under customary conditions was estimated as 0.76 mg, representing a fractional fluoride excretion of 39%. It is concluded that these children are possibly receiving suboptimal amounts of fluoride.

Urinary fluoride excretion in children drinking fluoridated school milk.

OBJECTIVE: To determine fluoride excretion under various conditions of fluoride intake and to estimate the fractional urinary excretion of fluoride in individual children participating in a school milk fluoridation scheme. DESIGN: In the first part of the study, individual urine samples were collected from each of eight 4 to 5-year-old children for a continuous period of 55 h. For each child (n = 8) and for each day (n = 3) the maximum urinary fluoride concentration (p.p.m.F), the maximum fluoride excretion rate (microgram F/h) and the total daily fluoride excretion (mg) were calculated. The second part of the study was carried out to determine the 24 h fractional percentage of fluoride excreted following administration of a known dose of fluoride in the absence of other sources. RESULTS: Under usual conditions of fluoride intake (i.e. milk containing 0.5 mg fluoride, customary diet and toothbrushing with fluoride toothpaste) the children's daily fluoride excretion was 0.33 mg. The fractional urinary fluoride excretion of a 0.5-mg fluoride tablet was 30%. CONCLUSIONS: It is concluded that the children's mean 24 h fluoride excretion was somewhere between that reported in low fluoride conditions and that reported in optimally fluoridated areas. The fractional urinary fluoride excretion was found to be in agreement with the findings of other workers.

Visual and radiographic diagnosis of occlusal caries in first permanent molars and in second primary molars.

Diagnosis of early occlusal caries has proved more difficult than that affecting smooth or approximal surfaces. With time, this type of lesion has come to form a greater proportion of caries as a whole and its accurate diagnosis is consequently becoming more important. The most widely used methods of diagnosis are visual inspection and bitewing radiography but the value of both of these for occlusal caries has been questioned. The aim of this study was to investigate the validity of diagnosis using each of these two methods in extracted teeth. A total of 100 first permanent molars and 100 second primary molars were used and teeth and sites with questionable or borderline caries were selected for examination. The condition of the tooth on section was used to validate. In these samples sensitivity of radiographic diagnosis was greater than that of visual diagnosis. Both methods showed good specificity. When radiographs were used together with visual examination the status of 82% of first permanent molars and 91% of second primary molars were correctly classified.

Formocresol toxicity: is there a suitable alternative for pulpotomy of primary molars?

Some concern has been expressed in recent years about the use of formocresol for vital pulpotomy treatment of primary molars. This paper reviews the literature concerning the toxicity of formocresol and considers the evidence for the use of calcium hydroxide and glutaraldehyde. It is concluded that more work is required in this field before an alternative to formocresol can be recommended and that, in the meantime, a 1:5 dilution of the standard formocresol solution should be used but not included in the zinc oxide-eugenol sublining.